Sr. Compliance Specialist
Skills
Business ProcessConflictConflict ResolutionExternal AuditsFraud InvestigationsHealthcareMedicaid
What the job involves
The main requirements, responsibilities and hiring steps.
Requirements
- Bachelor’s degree with 3+ years healthcare experience or Associate degree with 5+ years healthcare experience
- Extensive knowledge of Medicaid regulations
- Experience with exclusion screening and background checks
- Strong knowledge of billing and coding preferred
Nice to have
- Good judgment
- Self-starter
- Detail-oriented
- Thorough
- Reliable
- Multi-tasking
Day to day
- Review legal and compliance documents to support regulatory operations across active states
- Conduct internal and external audits, track findings, and respond appropriately for multiple jurisdictions
- Investigate fraud, waste, and abuse claims while providing clear recommendations and escalating concerns as needed